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CHAUTAUQUA/COACHMAN RIDGE RECLAIMED WATER PROJECT - 07-0053-UT - CERTIFICATE OF LIABILITY INSURANCE
ACORD CERTIFICATE OF LIABILITY INSURANCE TM DATE(MM /DD/YYYY) 06/26/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Livingston Insurance Agency PO Box 7439 West Columbia, SC 29171 NAMEACT Rachel Popkowski (A/ /CC,NN ,Ext): 803.791.1120 FAX No): 803 . 796 . 8957 ADDRess: rpopkowski @livingstoninsurancesc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Cincinnati Insurance Company 10677 INSURED GREGORY ELECTRIC COMPANY, INC. P. 0. Drawer 1419 Columbia, SC 29202 -1419 INSURER B : j 3 J �,_„ °'� !` iis ) a�}R INSURERC: EACH OCCURRENCE INSURERD: UAMAGE I U RtN I EU PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) INSURER F : COVERAGES CERTIFICATE NUMBER: 2013 -2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CP ' ( " i$� u A' ` "° 4'(jj*+ j 3 J �,_„ °'� !` iis ) a�}R 07/01/2014 -. EACH OCCURRENCE $ 500,000 UAMAGE I U RtN I EU PREMISES (Ea occurrence) $ 500 , 000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 500,000 X Broad Form Cont. GENERAL AGGREGATE $ 500,000 X Deductible - $5000. PRODUCTS - COMP /OP AGG $ 500,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES JECT PER: LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AUT OS F ' u64 fib— A7i� U ' ' 67/01/2014 COMBINED) LE LIMIT (Ea accident) $ 500, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER a DAMAGE r accident) $ $ X UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE CPP0812097 07/01/2013 07/01/2014 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased /Rented Equipment - Replacement Cost CPP0812097 07/01/2013 07/01/2014 $500,000. Any One Item $5,000. Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) THE $10 MILLION DOLLAR UMBRELLA FOLLOWS FORM AND IS EXCESS OVER ABOVE UNDERLYING POLICIES. Project: #07- 0053 -UT Chautauqua /Coachman Ridge Reclaimed Water Project Certificate holder is reflected as additional insured in regards to the General Liability per GA233 (02/07) CERTIFICATE HOLDER CANCELLATION City of Cl earwater 100 S. Myrtle Avenue Clearwater, FL 33756 -5520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a (� , ' �,- !�' Joseph Popkowski /SRH ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LABILITY COVERAGE PART A. Endorsement -Table of Contents: Coverage: • Berlins on Pace; 1. Employee Benefit Liability Coverage ». » »_.. . _ .. ».... »... »» . _ _ _._..»»_ »» _ „ 2 2. Unintentional Failure to Disclose Hazards_ . .„_ _ _.... »... ...._» _.._ ». ».. .» ._.... »_ 7 3. Damage to Premises Rented to You ». ».. »_...._. ».. »_ _ . ._ _ .. _ ...... »_..._......_....._». 8 4. Supplementary Payments 9 5. Medical Payments,....,.............,.._......._._......_..... 6. Voluntary Properly Damage (Coverage a,) and Care, Custody or Control Liability Coverage (Coverage b ). _ __ » .__. »r »_. _ .. .. .... .. .. »....» ... „ »._. 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations „_ . ».. „ „ „_.. »_.._._....._10 8. Waiver of Subrogation .» _..._ ».... __.. ....._._.._ _...__..__ ... .._.� ». _._10 9. AutomaticAdditional insured - Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment • Vendors; • State or Political Subdivisions - Permits Relating to Premises, • State or Political Subdivisions - Permits; and • Con tractors' Operations 10. Broadened Contractual Liability - Work Within So' of Railroad Property ...„ .._ _.. 14 11. Property Damage to Borrowed Equipment. Y _._.... ».... ...._.. ». ... _ .. _ ___. »..14 12. Employees as Insureds - Specified Health Care Services __.. _»____ .. „...» .14 • Nurses; • Emergency Medical Technicians, and • Paramedics 13. Broadened Notice of Occurrence.... »..... ».. _ _ _ _._. . ».. » „._ . » »_ »._... ». »__...._» .... _.14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse - ment, except as provided below: 1. Employee Benefit liability Coverage Each Employee Limit $ 1,000,000 Aggregate Limit $ 3,000,000 Deductible: $ 1,000 3- Damage to Premises Rented to You The lesserot a. The Each Occurrence Limit shown in the Declarations: or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 S. Medical Payments Medical Expense Limit $ 10,000 Includes copyrighted material of Insurance GA 233 92 07 Services Office, Inc., with its permission. Page 1 of 15 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b,) Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: 1. Employee Benefit Liability Coverage a. The following is added to SECTION I - COVERAGE& Employee Benefit Liability Coverage. (1) Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as dam- ages caused by any act, er- ror or omission of the in- sured, or of any other per- son for whose ads the in- sured is legally liable, to which this Insurance ap- plies. We will have the right and duty to defend the in- sured against any suit' seeldng those damages. However, we will have no duty to defend against any 'sure seeking damages to which this insurance does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or "suit* that may re- sult But 1) The amount we will pay for damages is funded as described in SEC- TION 18 - UMITS OF INSURANCE; and 2) Our right and duty to defend ends when we (b) Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. have used up the ap- plicable limit of insur- ance in the payment of judgments or settle - merits. No other obligation or liabil- ity to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Pay- merits. This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the administration' of your 'employee benefit pro- gram'; and 1) Occurs during the pol- icy period: or 2) Occurred prior to the effective date of this endorsement provided: a) You did not have knowledge of a claim or 'suit' on or before the ef- fective date of this endorsement. You will be deemed to have knowledge of a claim or 'suit” when any "authorized repre- sentative; Page 2 of 15 COVERAGE PREMIUM BASIS (b) A 11 (c) Gross Sales (d) Units (e) Other RATE (For Limits in F "mess of $5 000) ADVANCE PREMIUM (For Limas in Excess of $5A00) b. Care, Custody or Control $ TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: 1. Employee Benefit Liability Coverage a. The following is added to SECTION I - COVERAGE& Employee Benefit Liability Coverage. (1) Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as dam- ages caused by any act, er- ror or omission of the in- sured, or of any other per- son for whose ads the in- sured is legally liable, to which this Insurance ap- plies. We will have the right and duty to defend the in- sured against any suit' seeldng those damages. However, we will have no duty to defend against any 'sure seeking damages to which this insurance does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or "suit* that may re- sult But 1) The amount we will pay for damages is funded as described in SEC- TION 18 - UMITS OF INSURANCE; and 2) Our right and duty to defend ends when we (b) Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. have used up the ap- plicable limit of insur- ance in the payment of judgments or settle - merits. No other obligation or liabil- ity to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Pay- merits. This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the administration' of your 'employee benefit pro- gram'; and 1) Occurs during the pol- icy period: or 2) Occurred prior to the effective date of this endorsement provided: a) You did not have knowledge of a claim or 'suit' on or before the ef- fective date of this endorsement. You will be deemed to have knowledge of a claim or 'suit” when any "authorized repre- sentative; Page 2 of 15 GA 233 02 07 i) Reports all, or any part, of the ad. error or omission to us or any other insurer: i) Receives a written or ver- bal demand or claim for lam- ages becau of the act, er- ror or omis- sion; and b) There is no other applicable insur- ance. (2) Exclusions This insurance does not apply to: (a) Bodily Injury, Property Damage or Personal and Advertising injury ' Bodly injury 'property damage" or "personal and advertising injury. (b) Dishonest, Fraudulent, Criminal or Malicious Act Damages arising out of any intentional, dishonest, fraudulent, criminal or mali- cious act error or omission, committed by any insured, including the willful or reck- less violation of any statute. (c) Failure to Perform a Con- tract Damages arising out of fail- ure of performance of con- tract by any insurer. (d) Insufficiency of Funds Damages arising out of an insufficiency of funds to meet any obligations under any plan included in the "employee benefit pro- g ". (e) Inadequacy of Perform- ance of Investment ! Ad- vice Given With Respect to Participation Any claim based upon: 1) Failure of any Invest- ment to perform; 2) Errors in providing in- formation on past per- tormance of investment vehicles; or 3) Advice given to any person with respect to that person's decision to participate or not to participate in any plan included in the em- ployee benefit pro- (t) Workers' Compensation and Similar Laws Any claim arising out of your failure to comply with the mandatory provisions of any workers' compensation, unemployment compensa- tion insurance. social secu- rity or disability benefits law or any similar law. (g) ERISA Damages for which any in- sured is liable because of liability imposed on a fiduci- ary by the Employee Re- tirement Income Security Act of 1974, as now or hereafter amended, or by any similar federal, state or (h) Available Benefits Any claim for benefits to she extent that such benefits are available, with reason- able effort and cooperation of the insured, from the ap- plicable funds accrued or other collectible insurance. (i) Taxes, Fines or Penalties Taxes, fines or penalties, including those imposed under the Internal Revenue Code or any similar state or local law. © Employment Related Practices Any liability arising out of any: (1) Refusal to employ; (2) Termination of em- PicYment (3) Coercion, demotion, evaluation, reassign- ment discipline, defa- mation, harassment, humiliation, dsrrimina- li0n or Other employ- Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 15 ment - related practices, acts or omissions; or (4) Consequential ), liabilty or (3) above. This exclusion applies whether the insured may be held Gable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. (3) Supplementary Payments SECTION I - COVERAGES, SUPPLEMENTARY PAY- MENTS - COVERAGES A AND B also apply to this Coverage. b. Who is an Insured As respects Employee Benefit l labil- ity Coverage, SECTION 11 - WHO IS AN INSURED is deleted in its en- tirety and replaced by the following: (1) If you are designated in the Declarations as: (a) An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. (b) A partnership or joint ven- ture, you are an insured Your members, your part- ners, and their spouses are also insureds but only with respect to the conduct of your business. (c) A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are in- sureds, but only with re- spect to their duties as your managers. (d) An organization other than a partnership, joint or l ty venture limited you are an insured. Your 'executive officers° and di- rectors are insureds, but only with respect to their duties as your officers or di- rectors. Your stadcolders are also Insureds, but only with respeet to their liability as stocK idder5, GA 233 02 07 (e) A trust, you are an insured. Your trustees are also in- sureds, but only with re- spect to their duties as trustees. (2) Each of the following is also an insured: (a) Each of your 'employees' who is or was authorized to administer your 'employee benefit program'. (b) or persons, organizations proper temporary authori- zation to sr your 'employee benefit program" if you die, but only until your representative Is ap- pointed. (c) Your legal representative if you die, but only with re- spect to duties as such. That representative will have all your rights and du- ties under this Coverage Part (3) Any organization you newly ac- quire or form, other than a part- nership, joint venture or limited liability which company, hy maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization. However, cover - age under this provision: (a) Is afforded only until the 180th day alter you acquire or form the organization or the end of the policy period, whichever is earlier, and (b) Does not apply to any act. error or omission that was committed before you ac- quired or formed the or- ganization. c. Limits of Insurance As respects Employee Benefit Liabil- ity Coverage, SECTION lit - LIMITS OF INSURANCE is deleted in its en- tirety and replaced by the following; (1). The Limits of insurance shown in Section B. Limits of Insur- ance, 1. Employee Benefit Li- ability Coverage and the rules below far the most we will pay regardless of the number of: (a) Insureds; . Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 15 (b) Claims made or "suits' brought; (c) Persons or organizations making claims or bringing Acts, errors or omissions; or Benefits included in your 'employee benefit pm- gram". (2) The Aggregate Limit shown in Section B. Limits of Insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages because of acts, er- rors or omissions negligently committed in the "administra- tion" of your 'employee benefit program". (3) Subject to the limit described in ltn ScBoian Limit shown in B. Employee of Insurance, 1, Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages sus- tained by any one 'employee', including damages sustained by such "employee's' dependents and beneficiaries, as a result of: (a) An act, error or omission; or (b) A series of related acts, er- rors or omissions, regard- less of the amount of time that lapses between such acts, errors or omissions, negligently committed in the 'administration° of your 'em- ployee benefit program'. However, the amount paid un- der this endorsement shall not exceed, and will be subject to the limits and restrictions that apply to the payment of benefits in any plan included in the 'em- ployee benefit program'. (4) Deductible Amount (d) (e) (a) GA 233 02 07 Our obligation to pay dam- ages on behalf of the in- sured applies only to the amount of damages in ex- cess of the deductible amount stated in the Decla- rations as applicable to Each Employee. The limits of insurance shall not be reduced by the amount of this deductible. (b) The deductible amount stated in the Declarations applies to all damages sustained by any one 'em- ployee', including such 'employee's' dependents and beneficiaries. because of all acts, errors or omis- sions to which this insur- ance applies. (c) The terms of this insurance, including those with respect to: 1) Our right and duty to defend the insured against any 'suits' seeking those dam - age. and 2) Your duties, and the duties of any other in- volved Insured, in the event of an act, error or omission, or claim, apply irrespective of the application of the deductible amount. (d) We may pay any part or all of the deductible amount to effect settlement of any claim or 'suit' and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as we have paid. d- Additional Conditions As respects Employee Benefit Li- ability Coverage, SECTION IV - COMMERCIAL GENERAL LIABIL- iTY CONDITIONS is amended as follows: (1) Item 2. Duties in the Event of Occurrence, Offense, Claim or Suit is deleted in its entirety and replaced by the following: 2. Duties In the Event of an Act, Error or Omission, or Claim or Suit a. You must see to it that we are noti- fied as soon as practicable of an act, error or omission which may result in a claim. To the extent possible, no- tice should include: (1) What the act, error or omission was and when it occurred; and (2) The names and addresses of anyone who may suffer dam- ages as a result of the act, error or omission. Includes copyrighted material of insurance Services Office, Inc., with its permission. Page 5 of 15 b. if a claim is made or'suit' is brought against any insured, you must (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or 'suit' as soon as practicable. c. You and any other involved insured must (1) Immediately send us copies of any demands, notices, sum- monses or legal papers re- ceived in connection with the claim or "suit ; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investi- gation or settlement of the claim or defense against the suit; and (4) Assist us, upon our request? in the enforcement of any nght against any person or organiza- tion which may be liable to the insured because of an act, error or omission to which this insur- ance may also apply. d. No insured will, except at that in sured's own cost, voluntarily make a payment, assume any obligation, or incur any expense without our con- sent (2) item 5. Other Insurance is de- leted in its entirety and replaced by the following: 5. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under this Coverage Part, our obligations are (united asfolowc a. Primary Insurance This insurance is pri- mary except when c. below applies. if this insurance our obligations are p affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in b. below. GA 233 02 07 b. Method of Sharing If all of the other insur- ance permits contribu- tion by equal shares, we will follow this method also. Under this approach each in- surer contributes equal amounts until it has paid its applicable limit insuranon tof he loss ce or . renmae ins. of whichever comes fast if any of the other in- surance does not per- mit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of in- surance to the total ap- plicable Omits of insur- ance of all insurers. c. No Coverage This insurance shall not cover any loss for which the insured is entitled to recovery un- der any other insur- ance in force previous to the effective date of this Coverage Part. e. Additional Definitions As respects Employee Benefit Li- ability Coverage, SECTION V - DEFINmONS is amended as fol- lows: (1) The following definitions are added: 1. "Administration "means: a. Providing information to ert ployees', including their dependents and beneficiaries, with re- spell to eligib. ifity for or scope of 'employee benefit programs'; b. Interpreting the 'em- ployee benefit pro- grams'; a, Handling records in '9onnecton with the employee benefit pro- grams'; or d Effecting, continuing or terminating any em- ployee's' participation Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 15 GA 233 02 07 in any benefit included in the 'employee bene- fit program'. However, "administration" does not include: a. Handling payroll de- ductions; or b. The failure to effect or maintain or adequate limits of coverage of insurance, including but not limited to unemployment in- surance, social security benefits, workers' com- pensation a and disability 2. 'Cafeteria plans' means plan authorized by applica- ble law to allow "employ- ees' to elect to pay for cer- t fits with pre-tax dollars. 3. 'Employee benefit pro- grams' means a program providing some or all of the following benefits to "em- ployees', 'cafeteria plan' � otherwise: a. Group fife insurance; group accident or health insurance; den- tal. vision and hearing plans; and ftewbte spending accounts; provided that no one other than an 'em- tooysee may subscribe and bd such benefits are made generally available to those "employees' who satisfy the plan's efigi- bi tyfl uirer tg b. Profit sharing plans, employee savings plans, employee stock ownership plans, pen- sion plans and stock subscription plans, provided that no one other than an "em- wosuch ' may subscrib benefits d such benefits are made generally available to all 'employees' who are eligible under the plan forsuch benefits; G. Unemployment insur- ance. social security benefits, workers' com- pensation and disability benefits; and d. Vacation plans, includ- ing buy and sell pro- grams; leave of ab- sence programs, in- cluding military, mater- nity, family, and civil leave; tuition assis- tance plans: transpor- tation and health club subsidies. (2) The following definitions are deleted in their entirety and re- placed by the following: 21. 'Suit' means a civil pro- ceeding in which money damages because of an act, error or omission to which this insurance applies are alleged_ 'Suit" includes: a. An arbitration pro- ceeding in which such damages are claimed and to which the in- sured must submit or does submit with our consent; b. Any other alternative dispute resolution pro- ceeding in which such damages are claimed and to which the in- sured submits with our consent or a An appeal of a civil proceeding. 8. 'Employee' means a per- son actively employed, for - merly employed, on leave of absence or disabled, or retired. 'Employee" in- cludes a 'teased worker'. 'Employee' does not in- clude a "temporary worker". 2. Unintentional Failure to Disclose Haz- ards SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 7. Represen- tations is hereby amended by the addi- tion of the following: Based on our dependence gupon your representations oryou should fail hazards, ase all such hazards at the inception date of your policy, we will not reject coverage under this Coverage Part based solely on such failure. Includes copyrighted material of Insurance Services Office, inc.. with its permission. Page 7 of 15 3. Damage to Premises Rented to You a. The last Subparagraph of Paragraph 2, SECTION I - COVERAGES, COVERAGE A. - BODILY INJURY AND PROPERTY DAMAGE,. 2. LI- ABILITY Exclusions is eby de- leted and replaced by the following: Exclusions c. through q. do not vply to damage by fire, explosion, Gehl- nine, smoke or soot to premises while rented to you or temporarily occupied by you with permission of the owner. b. The insurance provided under SEC- TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY applies to 'property damage' arising out of water damage to premises that are both rented to and occupied by you. (1) As respects Water Damage Le- gal Liability, as . provided in Paragraph 3.b. above: The exclusions under SECTION 1 - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions, other than L War and the Nuclear Energy Liability Exclusion, are deleted and the following are added; This insurance does not apply to: (a) 'Property damage`. 1) Assumed in any con- tract Or 2) Loss caused by or re- sulting from any of the toilowing: a) Wear and tear; b) Rust, corosion, deterioration hid- den or latent de- fect n properly that drat causes it to dam- age or destroy it- self; a) Smog; d) Mechanical breakdown in- cluding rupture or bursting ed l by centrifucausga force; GA 2330207 e) Settling, cracking, shrinking or ex- pansion; or 1) Nesting or infesta- tion, or discharge or release of waste products or secretions, by in- sects, or other animals. (b) Loss caused directly or indi- rectly by any of the follow- ing: 1) Earthquake, volcanic eruption, landslide or any other earth move- ment 2) Wafer that backs up or overflows from a sewer, drain or sump; 3) Water under the ground surface press- ing seeping flowing h a) Foundations. walls, floors or paved surfaces; b) Basements, whether paved or not or c) Doors, windows or other openings. (c) from water that or resulting or flows from plumbing, heat- ing, air conditioning, or tire protection systems caused by or resulting from freez- ing, unless: 1) You did your bast to maintain heat in the building or structure; or 2) You drained the the iwwaateerrts and shut the off heal was not main- tained. (d) Loss to or damage to: 1) Plumbing, heating, air cortditoning, fire pro- tection systems, or other equipment or ap- pliances; or 2) The interior of any building or structure, or to personal property in the building or structure Includes copyrighted material of lrisuranCA Services Offiice, Inc., with its permission. Page 8 of 15 caused by or resulting from rain, snow, sleet or ice, whether driven by wind or not c. Limit of Insurance The Damage to Premises Rented to You Limit as shown in the Declara- tions is amended as folows (2) Paragraph 6. of SECTION ill - LIMITS OF INSURANCE is hereby deleted and replaced by the following: 6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, for damages because of property damage' to premises while rented to you or temporarily occupied by you with permission of the owner, arising out of any one 'occurrence' to which this insurance ap- plies. (3) The amount we wlil pay is lim- ited as described in Section B. Units of Insurance. 3. Dam- age to Premises Rented to You of this endorsement. 4. Supplementary Payments Under SECTION I - COVERAGE, SUP - PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. Paragraph 2. is replaced by the fol- lowing: Up to the Omit shown in Section B. Limits of Insurance, 4.a. Gall Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to the limit shown in Section B. Limits of Insurance, 4.b. toss of Earnings of this en- dorsement per day because of time off from Wort 5. Medical Payments The Medical Expense Limit of Any One Person as stated in the Declarations is amended to the limit shown in Section B. Limits of Insurance, 5. Medical Pay- ments of this endorsement. 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage a. Voluntary Property Damage Cov- erage We will pay for 'property damage' to property of others arising out of op- erations incidental to the insured's business when: (1) Damage is caused by the in- sured: or (2) Damage occurs while in the in- sured's possession. With your consent, we will make these payments regardless of fault b. Care, Custody or Control Liability Coverage SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, j. Damage to Property, Subparagraphs (3), (4) and (5) do not apply to 'property damage' to the property of others described therein. With respect to the insurance provided by this section of the endorsement, the fol- lowing additional provisions apply: a. The Limits of Insurance shown in the Declarations are replaced by the lim- its designated in Section B. Limits of Insurance, 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage of this endorsement with respect to cover- age provided by this endorsement These limits are inclusive of and not in adds ion to the limits being re- placed. The Limits of Insurance shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam- age and Care, Custody or Control Liability Coverage of this endorse - ment fix the most we will pay in any one 'occurrence' regardless of the number of: (1) Insureds (2) Claims made or 'suits' brought or (3) Persons or organizations mak- ing claims or bringing 'suits'. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 9 of 15 b. Deductible Clause (1) Our obligation to pay damages on your behalf applies only to the amount of damages for each "occurrence" which are in ex- cess of the deductible amount staled in Section B. Limits of Insurance, 6. Voluntary Prop- erty Damage and Care, Cus- tody or Control Liability Cov- erage of this endorsement, The limits of insurance will not be re- duced by the application of such deductible amount (2) Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit, applies to each claim or "suit" irrespective of the amount (3) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the ac- tion taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 7. 180 Day Coverage for Newly Formed or Acquired Organizations SECTION II - WHO IS AN INSURED is amended as follows: Subparagraph a. of Paragraph 4, is hereby deleted and replaced by the fol- lowing: a. Insurance under this provision is af- forded only until the 180th day after you acquire or form the organization or the end of the policy period. whichever is earlier, 8. Waiver of Subrogation SECTION IV - COMMERCIAL GENERAL UABIUTY CONDITIONS, 9. Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following: We waive any right of recovery we may have because o payments we make for injury or damage arising out of your on- going operations or 'your work' done un- der a written contract requiring such waiver with that person or organization and included in the 'products - completed operations hazard'. However, our rights may only be waived prior to the "occur- rence' giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring 'suit' or transfer those rights to us and help us enforce those rights. GA 233 02 07 9. Automatic Additional Insured - Speci- fied Relationships a. The following is hereby added to SECTION U- WHO IS AN INSURED (1) My person or organization de- scribed in Paragraph 9.a.(2) below (hereinafter referred to as additional insured) whom you are required to add as an addi- tional insured under this Cover- age Partbyreason of: (a) A written contract or agreement; or (b) An oral agreement or con- tract where a certificate of insurance showing that per- son or organization as an additional insured has been is an insured, provided: (a) The written or oral contract or agreement be 1) Currently in effect or becomes effective during • the policy pe- riod; and 2) Executed prior to an "occurrence" or offense to which this insurance would apply, and (b) They are not specifically named as an additional in- sured under any other pro- vision of, or endorsement added to, this Coverage Part (2) Only the following persons or organizations are additional in- sureds under this endorsement, and insurance coverage pro- vided to such additional in- sureds is limited as provided herein: (a) The manager or lessor of a premises leased to you with whom you have agreed per Paragraph 9.a.(1) above to provide insurance, but only with respect to liability aris- ing out of the ownership, maintenance or use of that part of a p remises leased to you, subject to the addiionall exclusions: This insurance does not apply to: 1) Any 'occurrence' which takes place after Includes copyrighted material of Insurance Services Office; Inc., with its permission. Page 10 of 15 GA 233 02 07 you cease to be a ten- c) Any physical or ant in that premises, chemical change in 2) Structural alterations, m -the product new construction or made intentionally demolition operations by the vendor, performed by or on be- d) Repackaging, un- halt of such additional less unpacked insured. solely for the pur- pose on (b) Any person or emonstraton, organization n um with whom you testing, , or the equipment agreed per Paragraph parts punder in s.s,(l) above to in- structions from the surance. Such person(s) or manufacturer, and organizations) are insureds then repackaged solely with respect to their in the original liabty arising out of the container maintenance, operation or use ayou of equipment e) Any failure to to you by such per - make such in- son(s) or organizations(s). spections, adjust- However, this insurance ments, tests or does not apply to any 'on- servicing as the currence' which lakes place vendor has after the equipment lease agreed to make or expires, normally under - (c) Any person or organization under- takes make in (referred to below as yen- the buu ss! course dor) with whom you have of business, in connexion with agreed per Paragraph the distribution or 9,3.(1) above to provide in- sate of the prod - surance, but only with re- ups; sped to "bodily Injury or 'property damage' arising 1) Demonstration, in- out of "your products" which stallation, servic- are distributed or sold in the ing or repair op- regular course of the ven- erations, except dam's business, subject to such operations the following additional ex- performed at the elusions: vendor's premises 1) The insurance afforded in connection wire the sale of the the vendor does not ply to: Product WAY a) 'sodny injury" or g) Products which, 'property.damage' after distribution yo e for which the yen- sale by you, have ated to been labeled Is ob beled ti9 . relabeled a or used pay damages by as a container, a reason as- of part or thing on of Iiab� ity m a contract or or substance by or agreement. This for the vendor. exclusion does not apply to liability for 2) This Insurance does damages that the not apply to any in- vendor would sured person or or- have in the ab- ganization: sence of the ton- g From whom f or agree- a r meat have acquired such products, or b) Any express war- any ingredient, rarity unauthorized part or container. by you: entering into, ac- Includes copyrighted material of insurance Services Office, Inc., with its permission. Page 11 of 15 GA 2330207 compenying or 2) This insurance does in- pproduct% or such jury', property dam - b) When liability lo- age' or 'personal and ads- eluded abilin the advertising rimy" ads - eludedcts- ing out of operations completed opera- or subdivision. dons hazard* has been under this excluded (fl Any person or organization and Part wither you have agreed per Paragraph 9.a.(1) spent ucts, bu t vonlY with respect to II- (dj Any state or political s arising t of 'your vision with wisdr_you have additional insured by you or agreed 9.a (1) above per to provide aim- on your behalf. A person or as surance, subject to the foe- organization's status an lowing additional prove ion: insured under this t canton of this endorsement contin- Thfs insurance applies only ues for only the period of with respect to the following time required by the written hazards for which the stale contract or agreement, but or political subdivision has in no event beyond the ex- issued a permit in connec- Oration date of this Cover- lion with premises you own, age Part If there is no rent or control and to which written contract or agree - this insurance applies ment, or if no period of time is required by the written 1) The existence, mainte- contract or agreement, a (lance, repair, con- person or organization's struction, erection, or status as an insured under removal of advertising this endorsement ends signs. awnings, cano- when your operations for pies, � entrances, that insured are completed. hole*, manholes, marquees. (3) Any insurance provided to an hoist away openings, insured designated sidewalk vaults, street under Paragraph 9-x42): banners, or decora- r similar expo- does not apply to 'bodily {a ) Subparagraphs (a) and ilf) lions and s'bodily injury' or "property damage 2) The construction, erec- Included within the "prod - lion, or removal of efe ucts- completed operations hazard' vators; or 3) The ownership, main- tenance, or use of any elevators covered by this Insurance. (e) Any state or political subdi- vrsron with which you have agreed per Paragraph 9.a.(1) above to provide in- surance, subject to the fol- lowing provisions: 1) This insurance applies only with respect op- erations performed by you or on your behalf for which the state or political subdivision has issued a permit (b) Subparagraphs end (1) (a), (apply to 'bodily injury", "property damage' or "personal and out of a �the sole nneglgene or willful misconduct of the addItionai insured or their agents, 'employees' or any other representative of the additional insured; or (c) Subparagraph CO does not apply to "bodily injury', "property damage' or "per- sonal and advertising injury arising out of: 1) Defects in design fur- nished by or on behalf Includes Copyrighted material of Insurance Services Office. Inc., with I1S paiission. Page 12 of 15 ot the additional in- suied or 2) The rendering of, or failure to render, any professional architec- tural, engineering or surveying services, in- cluding: a) The preparing, approving or fail- ing to prepare or approve maps, shop drawings, opinions, reports, surveys, field or- ders, change or- ders or drawings and spec cations; and b) Supervisory, in- spection, archi- tectural or engi- neering activities. 3) 'Your work' for which a consolidated (wrap -up) insurance program has been provided by the primecontractor- project manager or owner of the construction project in which you are in- volved. b. Only with regard to insurance pro- vided to an additional insured desig- nated under Paragraph 9a.(2) Sub- paragraph (f) above. SECTION lit - LIMITS OF INSURANCE is amended to include: The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Coverage Part, whichever are less. If no limits are specified in the written contract or agreement, or if there is no written contract or agreement, the limits ap- plicable to the additional insured are those specified in the Declarations of this Coverage Part The knits of in- surance are inclusive of and not in addition to the limits of insurance shown in the Declarations. c. SECTION IV - COMMERCIAL GEN- ERAL LiABiLTY CONDITIONS is hereby amended as follows: (1) Condition 5. Other Insurance is amended to include: (a) Where required by a written contract or agreement, this insurance is primary and or noncontributory as re- (2) spects any other insurance policy issued to the addi- tional insured, and such other insurance policy shall be excess and / or noncon- tributing, whichever applies, with this insurance. (b) Any insurance provided by this endorsement shall be primary to other insurance available to the additional insured except 1) As otherwise provided in SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, S. Other Insurance, b. Excess Insurance; or 2) For any other valid and collectible insurance available to the addi- tional insured as an additional insured by attachment of an en- dorsement to another insurance policy that is written on an eyl,e t basis. In such case, the coverage provided under this endorse- ment shall also be ex- cess. Condition 11. Conformance to Specific Written Contract or Agreement is hereby added: 11. Conformance to Specific Written Contract or Agreement With respect to additional insureds described in Para- graph 9.a.(2)(t) above only If a written contract or agreement between you and the additional insured specifies that coverage for the additional insured: a- Be provided by the In- surance Services Of- fice additional insured form number CG 2010 or CS 20 37 (where edition specified); or b. Include coverage for completed operations; or ' o Include coverage for your work": and where the limits or cov- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permissiot Page 13 of 15 tional insured is more re- strictive than was specifi- cally required in that written contract or agreement, the terms of 3)(a), 9.a.(31(hParagra) Or � above, or any combination thereof, shall be interpreted as providing the limits or coverage required by the terms of the written contract or agreement, but only to the extent that such limas or coverage is included within the terms of the Coverage Part to which this endorse- ment is attached. If, how- ever, the written contract or agreement specifies the In- surance Services Office additional insured form number CG 20 10 but does not specify which edition, or specifies an edition that does not exist. Paragraphs 9.a.(3)(a) and 9a(3)(b) of this endorsement shall not apply and Paragraph 9.b. of this endorsement shall ap- ply- 10. Broadened Contractual Liability - Work Within 50' of Railroad Property It is hereby agreed that Paragraph f.(1) of Definition 12. 'Insured contract' (SEC- TION V - DEFINIRONS) is deleted. 11. Property Damage to Borrowed Equip- ment a. The following is hereby added to Ex- clusion j. Damage to Property of Paragraph 2., Exclusions of SEC- TION I- COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LiABn1TY: Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform opera- tions at the time of loss. b. With respect to the insurance pro- vided by this section of the en- dorsement, the following additional provisions apply: (1) The limits of insurance shown in the Declarations are replaced by the limits designated in Sec- tion B. Limits of Insurance, 11. of this endorsement with respect to coverage provided by this endorsement These knits are inclusive of and riot in addition to the limits being replaced. The Units of Insurance shown in Section & Limits 01 Insurance, includes copyrighted material of Insurance 233 02 07 Services Office, Inc., with its permission. (2) 11, of this endorsement fix the most we will pay in any one 'oc- currence' regardless of the number ot (a) insureds; (b) Claims made or °suits' brought; or (c) Persons or organizations making claims or bring 'suits'. Deductible Clause (a) Our obligation to pay dam- ages on your behalf applies only to the amount of dam- ages for each 'occurrence' which are in excess of the Deductible amount stated in Section B. Limits of Insur- ance, 11. of this endorse- ment The funifs of insur- ance will not be reduced by the amount such De- ductible Condition 2. Duties in the Event of Occurrence, Of- fense, Claim or Suit, ap- plies to each claim or 'suit' irrespective of the amount (c) We may pay any part or all of the deductible amount to effect settlement of any claim or 'suit' and upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 12. Employees as Insureds - Specified Health Care Services It is hereby agreed that Paragraph 2.a.(1)(d) of SECTION 11 - WHO IS AN INSURED, does not apply to your 'em- ployees' who provide professional health care services on your behalf as duly li- censed: a. Nurses; b. Emergency Medical Technicians; or a Paramedics, in the jurisdiction where an 'occurrence' or offense to which this insurance applies takes place. 13. Broadened Notice of Occurrence Paragraph a. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI.- Page 14 of 15 TIONS) is hereby deleted and replaced by the following: a. You must see to it that we are noti- fied as soon as practicable of an °occurrene or an offense which may result in a claim To the extent possible, notice should include; (1) How, when and where the 'oc- currence' or offense took pia= (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence' or offense. This requirement applies only when the 'occurrence' or offense is known to an 'authorized representative'. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 15 of 15 ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 06/26/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Livingston Insurance Agency PO Box 7439 West Columbia, SC 29171 CONTACT Rachel Popkowski NAME: p PHONE ,EXt): 803.791.1120 FAX No): 803.796.8957 a ARASS: rpopkowski @livingstoninsurancesc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Cincinnati Insurance Company 10677 INSURED GREGORY ELECTRIC COMPANY, INC. P. 0. Drawer 1419 Columbia, SC 29202 -1419 INSURER B: CPPO`A 4ETM Ei ° t ' INSURERC: 07/01/2014 INSURER D: $ 500,000 INSURER E : $ 500,000 INSURER F : $ 10,000 COVERAGE CERTIFICATE NUMBER: 2013 -2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AWL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPPO`A 4ETM Ei ° t ' 97/01/2013 fiL, s '$J � 111 °4 A ,h,v 6 l r�3 a 07/01/2014 EACH OCCURRENCE $ 500,000 UAMAGE I O KEN I ED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 500,000 X Broad Form Cont. GENERAL AGGREGATE $ 500,000 X Deductible - $5000. PRODUCTS - COMP /OP AGG $ 500,000 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES jeCOT- PER: LOC�il $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS t-'/MP adekai tRfiI,:Ikf.Y.J1fi ®1/2014 COMBINED SINGLE LIMIT (Ea accident) $ 500,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER fY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CPP0812097 07/01/2013 07/01/2014 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased /Rented Equipment - Replacement Cost CPP0812097 07/01/2013 07/01/2014 $500,000. Any One Item $5,000. Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) THE $10 MILLION DOLLAR UMBRELLA FOLLOWS FORM AND IS EXCESS OVER ABOVE UNDERLYING POLICIES. Certificate holder is reflected as additional insured in regards to the General Liability per GA233 (02/07) DER CANCELLATION City of Clearwater 100 S. Myrtle Avenue Clearwater, FL 33756 -5520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a 4p4, Joseph Popkowski /SRH ACORD 25 (2010/05) -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement -Table of Contents: Coverage: • Beoins on Pace: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disclose Hazards „_ .. _ „_..__... .._. _...... ».. _. _ „ _.... .._ 7 3. Damage to Premises Rented to You . .„ __..._ . »_ __ _ _.__ _.. __...... »_.._......._....._.._. 8 4. 5. Medical Payments.„....._._._....... r......._ ............._............__..__._...__.�..__......._.__.......__ 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.)._ _ _ ....._... _ 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations ._ „. _. „._..„ .._ _... »_mm 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured - Specified Relationships:._ - m...__ .. ............__..-_.._____....10 - Managers or Lessors of Premises; - Lessor of Leased Equipment; • Vendors; - State or Political Subdivisions - Permits Relating to Premises; • State or Political Subdivisions - Permits; and • Contractors' Operations 10. Broadened Contractual Liability - Work Wdhin 50' of Railroad Property _.__ ..__....._. .._.. „....14 11. Property Damage to Borrowed Equrpment.._._.._._ ......... ...._-....„._..-...... .- .- ...,....._.-__....»..14 12. Employees as Insureds - Specified Health Care Services _._.._...__._ ........._.14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence.... ... 14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below. 1. Employee Benefit Liability Coverage Each Employee Limit $ 1,000,000 Aggregate Limit $ 3,000,000 Deductible: $ 1.000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds $ 1,000 b. Loss of eammgs: $ 350 5. Medical Payments Med heal Expense Limit $ 10,000 includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 1 of IS 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $1,000 . Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: 1. Employee Benefit Liability Coverage a. The following is added to SECTION I COVERAGES: Employee Benefit Liability Coverage. (1) Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as dam- ages caused by any act, er- ror or omission of the in- sured, or of any other per- son for whose acts the in- sured is legally liable, to which this insurance ap- plies. We will have the right and duty to defend the in- sured against any suit' seeking those damages. However, we will have no duty to defend against any 'sue seeking damages to which this insurance does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or "suit' that may re- sult. But 1) The amount we will pay for damages is limited as described in SEC- TION lii - LIMITS OF INSURANCa and 2) Our right and duty to defend ends when we have used up the ap- plicable limit of insur- ance in the payment of judgments or settle- ments. No other obligation or liabil- ity to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Pay- ments. (b) This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the administration' of your 'employee benefit pro- gram'; and 1) Occurs during the pol- icyperiod: or 2) Occurred prior to the effective date of this endorsement provided: a) You did not have knowledge of a claim or 'suit' on or before the ef- fective date of this endorsement. You will be deemed to have knowledge of a claim or 'suit” when any 'authorized repre- sentative; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 2 of 15 COVERAGE PREMIUM BASIS (a) Area (b) Payroll (o) Gross Sales (d) Units (e) Other RATE (For Limits OOOExcessof ADVANCE PREMIUM (For Limits in of b. Care, Custody or Control $ TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: 1. Employee Benefit Liability Coverage a. The following is added to SECTION I COVERAGES: Employee Benefit Liability Coverage. (1) Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as dam- ages caused by any act, er- ror or omission of the in- sured, or of any other per- son for whose acts the in- sured is legally liable, to which this insurance ap- plies. We will have the right and duty to defend the in- sured against any suit' seeking those damages. However, we will have no duty to defend against any 'sue seeking damages to which this insurance does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or "suit' that may re- sult. But 1) The amount we will pay for damages is limited as described in SEC- TION lii - LIMITS OF INSURANCa and 2) Our right and duty to defend ends when we have used up the ap- plicable limit of insur- ance in the payment of judgments or settle- ments. No other obligation or liabil- ity to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Pay- ments. (b) This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the administration' of your 'employee benefit pro- gram'; and 1) Occurs during the pol- icyperiod: or 2) Occurred prior to the effective date of this endorsement provided: a) You did not have knowledge of a claim or 'suit' on or before the ef- fective date of this endorsement. You will be deemed to have knowledge of a claim or 'suit” when any 'authorized repre- sentative; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 2 of 15 GA 233 02 07 I) Reports all, or any part, of the act, error or omission to us or any other insurer, II) Receives a written or ver- bal demand or claim for dam- ages because of the act. er- ror or omis- sion; and b) There is no other applicable issu- ance. (2) Exclusions This insurance does not apply to: (a) Bodily Injury, Property Damage or Personal and Advertising injury 'Bodily injury' "property damage" or 'personal and advertising injury'. (b) Dishonest, Fraudulent, criminal or Malicious Act Damages arising out of any intentional, dishonest, fraudulent, criminal or mali- cious act, error or omission, committed by any insured, including the willful or reck- less violation of any statute. (c) Failure to Perform a Con- tract Damages arising out of fa0- ure of performance of con- tract by any insurer. (d) Insufficiency of Funds Damages arising out of an Insufficiency of funds to meet any obligations under any plan included in the 'employee benefit pro- gram". (e) Inadequacy of Perform- ance of Investment I Ad- vice Given With Respect to Participation Any claim based upon: 1) Failure of any invest- ment to parlour% 2) Errors in providing in- formation on past per- (f) (g) (h) fonnance of investment vehicles; or 3) Advice given to any person with respect to that person's decision to participate or not to participate in any inn included in the 'em- ployee benefit pro- Workers' Compensation and Similar Laws My claim arising out of your failure to comply with the mandatory provisions of any workers' compensation, unemployment compensa- tion insurance, social secu- rity or disability benefits law or any similar law. ERMSA Damages for which any in- sured is liable because of liability imposed on a fiduci- ary by the Employee Re- tirement Income Security Act of 1974, as now or hereafter amended, or by any lomlar federal, state or local Available Benefits Any claim for benefits to the extent that such benefits are available, with reason- able effort and cooperation of the insured from the ap- plicable funds accrued or other collectible insurance. (I) Taxes, Fines or Penalties Taxes, lines or penalties, including those imposed under the Internal Revenue Code or any similar state or local law. (j) Employment- Related Practices Any liability arising out of (1) Refusal to employ; (2) Termination of em- ployment; (3) Coercion, demotion, evaluation, reassign- ment, discipline, defa- mation, harassment, humiliation, discrimina- tion or other employ- Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 15 ment - related practices, acts or omissions; or (4) Consequential lialaTity as a result of (1), (2) or (3) above. This exclusion applies whether the insured may be held liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. (3) Supplementary Payments SECTION t - COVERAGES, SUPPLEMENTARY PAY - MENTS - COVERAGES A AND B also apply to this Coverage. b. Who is an Insured As respects Employee Benefit liabil- ity Coverage, SECTION U - WHO IS AN INSURED is deleted in its en- tirety and replaced by the following: (1) If you are designated in the Declarations as: (a) An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. (b) A partnership or joint ven- ture, you are an insured. Your members, your part- ners, and their spouses are also insureds but only with respect to the conduct of your business. (c) A limited Lability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are in- sureds, but only with re- spect to their duties as your managers. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your executive officers' and di- rectors are insureds, but only with respect to their duties as your officers or di- rectors. Your stockholders are also insureds, but only with respect to their liability as stocknolders. . includes copyrighted material of Insurance Services Office, Inc., with its permission. GA 233 02 07 (d) (2) (e) A trust, you are an insured. Your trustees are also in- sureds, but only with re- spect to their duties as trustees. Each of the following is also an insured: (a) Each hodt who is or was authorized administer your 'employee benefit program'. (b) or ory es' having proper temporary authori- zation to administer your 'employee benefit program' if you die, but only until your legallrepresentative is ap- (c) Your legal representative if you die, but only with re- spect to duties as such. That representative will have all your rights and du- ties under this Coverage Part (3) Any organization you newly ac- quire or form, other than a part- nership, joint venture or limited liability company, and over which you maintain ownershi or majority interest, will q as a Named Insured if no other similar insurance apples to that organization. However, cover- age under this provision: (a) Is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, and (b) Does not apply to any act, error or omission that was committed before you ac- quired or formed the or- ganization. c. Limits of Insurance As respects Emplo yee Benefit Liabl- ity Coverage, SECTION ill - LIMITS OF INSURANCE is deleted in its en- tirety and replaced by the folowing: (1). The Limits of insurance shown in Section B. Limits of Insur- ance, 1, Employee Benefit Li- ability Coverage and the rules below lix the most we will pay regardless of the number of: (a) Insureds, Page 4 of 15 (b) Claims made or 'suits' brought; (c) Persons or organizations making claims or bringing "suits", (d) Acts, errors or omissions; or (e) Benefits included in your ' employee benefit pro- gram". (2) The Aggregate Umit shown in Section B. Limits of insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages because of acts, er- rom or omissions negligently committed in the "administra- tion' of your "employee benefit program". (3) Subject to the limit described in (2) above, the Each Employee Limit shown in Section B. Limits of Insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages sus- tained by any one 'employee', including damages sustained by such dependents and es, as a result of (a) An act, error or omission; or (b) A series of related acts, er- rors or omissions, regard- less of the amount of time that lapses between such acts, errors or omissions, negligently committed in the "administration" of your 'em- ployee benefit program'. However, the amount paid Un- der this endorsement shall not exceed, and will be subject to the Omits and restrictions that apply to the payment of benefits in any plan included In the °em- ployee benefit program'. (4) Deductible Amount (a) GA 233 02 07 Our obligation to pay dam- ages on behalf of the in- sured applies only to the amount of damages in ex- cess of the deductible amount stated in the Decla- rations as applicable to Each Employee. The limits of insurance shall not be reduced by the amount of this deductible. (b) The deductible amount stated in the Declarations applies to all damages sustained by any one 'em- ployee, including such "employee's' dependents and beneficiaries, because of all acts, errors or omis- sions to which this insur- ance applies. (e) The terms of this insurance, including those with respect to: 1) Our right and duty to defend the insured against any "suits" seeking those dam- age and 2) Your duties. and the duties of any other in- volved Insured, in the event of an act, error or omission, or claim, apply irrespective of the application of the deductible amount (d) We may pay any part or au of the deductible amount to effect settlement of any claim or "suit' and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as we have paid. d. Additional Conditions As respects Employee Benefit Li- ability Coverage, SECTION IV - COMMERCIAL GENERAL LIABIL. ITV CONDITIONS is amended as follows: (1) Item 2. Duties in the Event of Occurrence, Offense, Claim or Suit is deleted in its entirety and replaced by the following 2. Duties in the Event of an Act, Error or Omission, or Claim or Suit a. You must see to it that we are noti- fied as soon as practicable of an act. error or omission which may result in a claim. To the extent possible, no- tice should include: (1) What the act, error or omission was and when it occurred; and (2) The names and addresses of anyone who may suffer dam- ages as a result of the act, error or omission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 15 b. If a claim is made or "suit' is brought against any insured, you must (1) Immediately record the specifics of the claim or 'suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or 'suit' as soon as practicable. c. You and any other involved insured must (1) Immediately send us copies of any demands, notices, sum- monses or legal papers re- ceived in connection with the claim or'suit ; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the Investi- gation or settlement of the claim or defense against the 'suit'; and (4) Assist us. upon our request, in the enforcement of any right against any person or organiza- tion which may be Gable to the insured because of an act; error or omission to which this insur- ance may also apply. d. No insured will. except at that in- sureds own cost, voluntarily make a payment, assume any obligation, or incur any expense without our con- sent (2) Item 5. Other Insurance is de- leted in its entirety and replaced by the following: 5. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under this Coverage Part, our obligations are limited as follow= a. Primary Insurance This insurance is pri- mary except when c. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance Is also primary. Then, we will share with all that other insurance by the method described in b. below, GA 233 02 07 b. Method of Sharing If all of the other insur- ance permits contribu- tion by equal shares, we will follow this method also. Under this approach each in- surer contributes equal amounts until it has paid its applicable omit of insurance or none of the loss remains, whichever comes fist If any of the other in- smurance does pr- it contribution rot e by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of in- surance to the total ap- plicable limits of insur- ance of all insurers. c. No Coverage This insurance shall not cover any loss for which the insured is entitled to recovery un- der any other insur- ance in force previous to the effective date of this Coverage Part e ▪ Additional Definitions As respects Employee Benefit Li- ability Coverage, SECTION V - DEFINMONS is amended as fol- lows: (1) T following definitions are addect 1. 'Administration' means: a. Providing information to 'employees', including their dependents and beneficiaries, with re- spect to eligibility for or scope of 'employee benefit programs'; b. Interpreting the "em- ployee benefit pro- grams': c. Handling records in connection 'employee benefit with pro-the grams"' or it Effecting, continuing or terminating any em- ployee's" participation Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 15 GA 2330207 in any benefit included in the 'employee bene- fit program'. However, 'administration' does not include: a. Handling payroll de- ductions; or is The failure to effect or maintain any insurance or adequate . snits of coverage of insurance, including but not limited to unemployment in- surance, social security benefits, workers' com- pensation aa and disability 2. 'Cafeteria plans' means plan authorized by applica- ble law to allow 'employ- ees" to elect to pay for cer- tain benefits with pre -tax dollars. 3. 'Employee benefit pro- grams' means a program providing some or all of the following benefits to 'ern - ployees , whether provided through a "cafeteria plan' or otherwise: a. Group life insurance; group accident or health insurance; den- tal, vision and hearing plans and flexible spending accounts; provided that no one other than an "em- to oyee" may subscribe to such benefits and such benefits are made generally available to those "employees' who satisfy the plan's eflgi- tnffity requirements is Profit sharing plans. employee savings plans, employee stock ownership plans, pen- non plans and stock subscription plans, provided that no one other than an 'em- ployee' may subscribe to such benefits and such benefits are made generally all 'employees' who are eligible under the plan for such benefits; C. Unfnp(oymant insur- ance. social security benefits, workers' com- pensation anndd disdisability i benefs% d. Vacation plans, includ- ing buy and sell pro- grams; leave of ab- sence programs, in- cluding military, mater- nity, family, and civil leave; tuition assis- tance plans; transpor- tation and health club subsidies. (2) The following definitions are deleted in their entirely and re- placed by the following: 21. 'Suit means a civil pro- ceeding in which money damages because of an ad, error or omission to which this insurance applies are alleged. "Suit includes: a. An arbitration pro- ceeding in which such damages are claimed and to which the in- sured must submit or does submit with our consent b. Any other alternative dispute resolution pro- ceeding in which such damages are claimed and to which the in- sured submits with our consent or c. An appeal of a civil proceedi 8. "Employee' meng. ans a per- son actively employed, for- merly employed, on leave of absence or disabled, or retired. 'Employee' in- cludes a 'leased worker'. 'Employee' does not in- clude a - temporary worker". 2. Unintentional Failure to Disclose Raz. ards SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. 7. Represen- tations is hereby amended by the addi- tion of the 'following: Based on our dependence upon your representations as to existing hazards, if unintentionally you should tail to disclose all such hazards at the inception date of your policy, we will not reject coverage under this Coverage Part based solely on such failure. Includes copyrighted material of Insurance Services Office, Inc.. with its permission. Page 7 of 15 3. Damage to Premises Rented to You a. The last Subparagraph of Paragraph 2, SECTION 1 - COVERAGES, COVERAGE A. - BODILY INJURY AND PROPERTY DAMAGE,- 2. U. ABILITY Exclusions is hereby de- leted and replaced by the following: Exclusions C. through q. do not apply to damage by fire, explosion, ll ht- ning, smoke or soot to premises while rented to you or temporally occupied by you with permission of the owner. b. The insurance provided under SEC- TION I - COVERAGES, COVERAGE A, BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY applies to 'property damage' arising out of water damage to premises that are both rented to and occupied by you. (1) As respects Water Damage Le- gal Liability, as , provided in Paragraph 3b. above: The exclusions under SECTION /- COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY. 2. Exclusions, other than L War and the Nuclear Energy Liability Exclusion, are deleted and the following are added: This insurance does not apply to: (a) 'Property damage': 1) Assumed in any con- tract or 2) re- suiting from any of the following: a) Wear and fear, b) Rust, corrosion, fungus, decay, deterioration, hid- den or latent de- fect or any quality in property that causes it to dam- age or destroy iT- self; c) Smog; d) Mechanical breakdown in- cluding ru d bur by centrifugal force; GA 233 02'07 e) Settling, cracking, shrinking or ex- pansion; or f) Nesting or infesta- tion, or discharge or release of waste products or secretions, by in- dents other animate. (b) Loss caused directly or indi- rectly by any of the follow- ing: 1) Earthquake, volcanic eruption, landslide or any other earth move - ment 2) Water that backs up or overflows from a sewer, drain or sump; 3) Water under the Around surface ress- ghrig or seeping a) Foundations, walls, floors or paved surfaces; b) Basements, whether paved or not; or c) Doors, windows or other openings. (c) Loss caused by or resulting from water that leaks or flows from plumbing, heat- ing, air conditioning, or fire protection systems by un ,,less resulting train fire - e 9 1) You did your best to maintain heat in the building or structure; or 2) You drained the equipment and shut off the water supply if the heat was not main- tained. (d) Loss to or damage to: 1) Plumbing, heating, air tcctionn�sysystem , p a or other for ap- • w 2) The interior of any building or structure, or to personal property in the building or structure Includes copyrighted materfaf of Insurance Services Office, Inc., with its permission. Page S of 15 caused by or resulting front rain, snow, sleet or ice, whether driven by wind or not. C. limit of Insurance The Damage to Premises Rented to You Limit as shown in the Declara- tions is amended as follow= (2) Paragraph 6. of SECTION III - L LIMITS OF INSURANCE is hereby deleted and replaced by the following: 6, Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LABILITY, for damages because of "property damage" to premises while rented to you or y occuied by you with nperrmission of the owner, arising out of any one 'occurrence' to which this insurance ap- plies. (3) The amount we will pay is lim- ited as described in Section B. Limits of Insurance. 3. Dam- age to Premises Rented to You of this endorsement. 4. Supplementary Payments Under SECTION I - COVERAGE, SUP- PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. Paragraph 2. is replaced by the fol- lowin¢ Up to the limit shown in Section B. Limits of insurance, 4.a. Bail Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising, out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to the Omit shown in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- dorsement per day because of time off from work. 5, Medical Payments The Medical Expense Limit of Any One Person as stated in the Declarations is amended to the limit shown in Section B. Limits of Insurance, 5, Medical Pay- ments of this endorsement. 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage a. Voluntary Property Damage Cov- erage We will pay for 'property damage' to properly of others arising out of op- erations incidental to the insured's business when: (1) Damage is caused by the in- sured: or (2) Damage occurs while in the in- sured's possession. With your consent, we will make these payments regardless of fault b. Care, Custody or Control Liability Coverage SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LABILITY, 2. Exclusions, j. Damage to Property, Subparagraphs (3), (4) and (5) do not apply to 'property damage' to the property of others described therein. With respect to the insurance provided by this section of the endorsement, the fol- lowing additional provisions apply: a. The Limits of Insurance shown in the Declarations are replaced by the lim- its designated in Section B. Limits of Insurance, 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage of this endorsement with respect to cover- age provided by this endorsement These limits are inclusive of and not in addition to the limits being re- placed. The Limits of Insurance shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam- age and Care, Custody or Control Liability Coverage of this endorse- ment fix the most we will pay in any one 'occurrence' regardless of the number of: (1) Insureds; (2) Claims made or 'suits' brought; or (3) Persons or organizations mak- ing claims or bnnging 'suits ". Includes copyrighted material of Insurance GA 233 02 07 Services Office, lnC., with its permission. Page 9 of 15 b. Deductible Clause (1) Our obligation to pa damages on your behalf applies only to the amount of damages for each 'occurrence' which are in ex- cess of the derlu,tihIP amount staled in Section B. Limits of Insurance, 6. Voluntary Prop- erty Damage and Care, Cus- tody or Control Liability Cov- erage of this endorsement. The limits of insurance will not be re- duced by the application of such deductible amount Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit, applies to each claim or 'suit" irrespective of the amount We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the ac- tion taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 7. 180 Day Coverage for Newly Formed or Acquired Organizations SECTION 0 - WHO IS AN INSURED is amended as follows: Subparagraph a. of Paragraph 4- is hereby deleted and replaced by the fol- lowing: a. Insurance under this provision is af- forded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, 8. Waiver of Subrogation SECTION IV - COMMERCIAL GENERAL LIABILfrY CONDITIONS, 9. Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following: We waive any light of recovery we may have because of payments we make for injury or damage arising out of your on- going operations or 'your work" done un- der a written contract requiring such waiver with that person or organization and included in the 'products - completed operations hazard'. However, our rights may only be waived prior to the 'occur- rence' giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our fights. At our request, the insured will bring 'suit' or transfer those rights to us and help us enforce those rights. (2) (3) GA 233 02 07 9. Automatic Additional Insured - Speci- fied Relationships a. The following is hereby added to SECTION II - WHO IS AN INSURECt (1) Any person or organization de- scribbelow (hereinafter rreferred as additional insured) whom you are required to add as an addt- tlonal insured under this Cover age Part by reason of: (a) A written contact or agreement; or (b) An oral agreement or con- tract where a certificate of insuran a showing that per- son or organization as an additional insured has been issued. is an insured, provided: (a) The written or oral contract or agreement is: 1) Currently in effect or becomes effective during • the policy pe- riod; and 2) Executed prior to an 'occurrence' or offense to which this insurance would apply: and (b) They are not specifically named as an additional in- sured under any other pro- vision of, or endorsement added to, this Coverage Part (2) Only the following persons or organizations are additional in- sureds under tads endorsement and insurance coverage pro- vided to such additional in- sureds is railed as provided herein: (a) The nger lessyoo ofi premises maa leased to u r witha whom you have agreed per Paragraph 9.a.(1) above to provide inurance, but only with respect to liability aris- ing, out of the ownership, maintenance or use of that pan of a premises leased to aaddiitionall exclusion This insurance does not aPPlY to: 1) Any takes place after Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 10 of 15 GA 233 02 07 you cease to be a ten- ant in that premises. 2) Structural alterations, new construction or demolition operations performed by or on be- half of such additional insured. c) Any physical or chemical change in • the product made intentionally by the vendor; d) Repackaging, un- less unpacked solely for the pur- (b) Any person or organization ddam o tratrabon, n, from which you lease testing, . or the equipment with whom you substitution of have agreed per Paragraph pans under In- 9.a -(1) above to provide in- strucuons from the surance. Such person(s) or manufacturer, and organizations) are insureds then repackaged solely with respect to their in the original arising out of the container; maintenance, operation or use by you of equipment e) Any failure to leased to you by such per- make such in- son(s) or organizations(s). spections, adjust - Iiowever, this insurance meets, tests or does not apply to any 'cc- servicing as the currence" which takes place vendor has after the equipment lease agreed to make or expires, normally under - (c) Any person or organization thee. make in (referred to below as tree- s buu n coursn o dor) with whom you have f ctiess to connection with agreed per Paragraph 9,a.(1) above to provide in- the distribution the d- surence, but only with re- sale of the prod - spect to 'bodily injury or ucls; 'property damage' ansirg f) Demonstration, in- out of `your products" which stallalion, servic- are distributed or sold In the ring or repair op- regular course of the van- erations, except dot's business, subject to such operations the elisions: following ar�ifional ex- performed at vendor's premises 1) The insurance afforded to cosne the vendor does not the sale e o of f th he apply to: product a) "Bodily injury or g) Products which, after distribution or for damage" the van- sale by you, have been labeled or dor is obligated to . relabeled or used pay damages by as a container. reason Of the as- part or ingredient sumption of habi- of any other thing ity in a contractor or substance by or agreement. This for the vendor. exclusion does not apply to Lability for 2) This insurance does damages that the not apply to any in- vendor would steed person or or- have in the ab- ganizaton: sense of the con- tract or agree- a) From whom you anent; have acquired such products, or b) Any express war - any ingredient, rarity unauthorized part or container, by ypg: entering into, ac- Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 11 of IS GA 233 02 07 companying or containing such products: or b) When liability in- cluded within the 'products- completed opera- tions hazard' has 2) This Insurance does not apply to 'bodily in- jwy, property dam- age' or 'personal and advertising injury' aris- ing out of operations oorr polo ticl subdivision. been excluded (t) My person or organization under this Cover- with which you have agreed age Part with re- per Paragraph. 9,a.(1) spect to such above to provide insurance, products- but only with respect to L- (d) My state or polecat aubdi- tvorkf p of thatt vision with whichyo you have additional Insured by you or agreed per Paragraph on your behalf. A person or 9,a,(1) above to provide ire organization's status as an .trance, subject to the tot- insured under this provision towing additional provision: of this endorsement contin- This insurance applies only ues for only the period of with respect to the following time required by the written contract or agreement, but or rppolitical subdivision has in no event beyond the ex- issued a permit in conned piration date of this Cover - lion with premises you own, age Part if there is no rent or control and to which written contract or agree- this Insurance apples meet, or if no period of fime is required by the written 1) The existence, mainte- contract or agreement, a name, repair, con- person or organization's situation, erection, or status as an insured under removal of advertising this endorsement ends signs, awnings, cano- when your operations for pies, cellar entrances. that Insured are completed. coal holes, driveways, (3) Any insurance provided to an olds, marquees, additional insured designated sidewalk vaults, street under Paragraph 9.a.(2): banners, or decora- (a) Subparagraphs (a) and (ry lions and similar expo- does not apply to 'bodily sure., or injury' or 'properly damage• 2) The construction, eneo included within the "prod- ton, or removal of ele- ucts- completed operations vators or b•% 3) The ownership, main- tenance, or use of E elevators covered by this Insurance. (e) Any state or ponce' subdi- vision with which you have 9,a.(1)1) above to provide in- surance, subject to the fol- lowing provisions: 1) This insurance applies op- erations pperformed by you or on your behalf for which the state or political subdivision has issued a permit (b) (e Subparagraphs ad (f) des (a), (d), to 'bodily injury, 'property damage' or 'personal and advertsing injury' arising out Of the sole negligence or willful misconduct of the additional insured or their agents, 'employees' or any other representative of the additional Insured; or (c) Subparagraph does not apply to �ly injury', "property damage" or "per- sonal and advertising injury' arising out of 1) Defects in design fur- nished by or on behalf Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 12 of 15 4� of the additional in- sured; or 2) The rendering of, or failure to render, any professional architec- tural, engineering or surveying services, in- cluding: a) The preparrutg, approving or fail- ing to prepare or aPProve map% shop drawings, opinions, reports, surveys, field or- ders, change or- ders or drawings and specifications; and b) Supervisory, in- spection, archi- tectural or engi- neering activities. 3) Your work' for which a consolidated (wrap -up) insurance program has been provided by the primecontractor- project manager or owner of the construction project in which you are in- volved. b. Only with regard to insurance pro- vided to an additional insured desig- nated under Paragraph 9a(2) Sub- paragraph (t) above, SECTION III - LlltdfTS OF INSURANCE is amended to include: The limits applcable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Coverage Part, whichever are less. If no limits are specified in the written contract or agreement, or if there is no written contract or agreement, the limits ap- plicable to the additional insured are those specified in the Declarations of this Coverage Part The limits of in- surance are inclusive of and not in addition to the Omits of insurance shown in the Declarations. c. SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS is hereby amended as follows: (1) Condition 5. Other Insurance is amended to include: 4... (a) Where required by a written contract or agreement, this insurance is primary and l or noncontributory as re- spects any other insurance policy issued to the addi- tional insured, and such other Insurance policy shall be excess and / or noncon- tributing, whichever applies, with this insurance. (b) Any insurance provided by this endorsement shall be primary to other insurance available to the additional insured except 1) As otherwise provided in SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 5. Other Insurance, b. Excess Insurance; or 2) For any other valid and collectible insurance available to the addi- tional insured as an additional insured by attachment of an en- dorsement to another insurance policy that is written on an excess basis. In such case, the coverage provided under this endorse- ment shall also be ex- cess. (2) Condition 11. Conformance to Specific Written Contract or Agreement is hereby added: 11. Conformance to Specific Written Contract or Agreement With respect to additional insureds described in Para- graph 9.a.(2)(f) above only: If a written contract or agreement between you and the additional insured specifies that coverage for the additional insured: a. Be provided by the in- surance Services Of- fice additional insured form number CG 2010 or CE 20 37 (where edition specified); or b. include coverage for completed operations; or ' c. Include coverage for "your work"; and where the limits or cov- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 13 of 15 tional insured is more re- strictive than was specifi- cally required in that written contract or agreement, the terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. above, or any combination thereof, shall be interpreted as providing the Limits or coverage required by the terms of the written contract or agreement, but only to the extent that such limits or coverage is included within the terms of the Coverage Part to which this endorse- ment is attached. If, how- ever, the written contract or agreement specifies the In- surance Services Office additional insured form number CG 20 10 but does not specify which edition, or specifies an edition that does not exist, Paragraphs 9a.(3)(a) and 9.a.(3)(b) of this endorsement shall not apply and Paragraph 9.b. of this endorsement shall ap- pN. 10. Broadened Contractual Liability - Work Within 50' of Railroad Property It is hereby agreed that Paragraph f.(1) of Definition 12. 'Insured contract" (SEC- TION V - DEFINITIONS) is deleted. 11. Property Damage to Borrowed Equip- ment a. The following is hereby added to Ex- clusion j. Damage to Property of Paragraph 2., Exclusions of SEC- TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform opera- tions at the time of loss. b. With respect to the insurance pro- vided by this section of the en- dorsement, the following additional provisions apply: (1) The Limits of insurance shown in the Declarations are replaced by the limits designated in Sec- tion B. Limits of insurance, 11. of this endorsement with respect to coverage provided by this endorsement These grunts are inclusive of and riot in addition to the limits being replaced. The Limits of insurance shown in Section B. Limits of insurance, includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission 11, of this endorsement fix the most we will pay in any one "oc- currence' regardless of the number of (a) insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bring 'suns'. (2) Deductible Clause (a) Our obligation to pay darn- ages on your behalf applies only to the amount of dam- ages for each 'occurrence' which are in excess of the Deductible amount stated in Section B. Limits of Insur- ance, 11. of this endorse- ment. The limits of insur- ance will not be reduced by the application of such De- ductible amount (b) Condition 2. Duties in the Event of Occurrence, Of- fense, Claim or Suit, ap- plies to each claim or 'suit' irrespective of the amount (c) We may pay any part or all of the deductible amount to effect settlement of any claim or 'suit' and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 12. Employees as Insureds - Specified Health Care Services It is hereby agreed that Paragraph 2a(1)(d) of SECTION 0 - WHO IS AN INSURED, does not apply to your 'em- ployees" who provide professional health care services on your behalf as duly li- censed: a. Nurses; b. Emergency Medical Technicians; or c. Paramedics, in the jurisdiction where an "occurrence' or offense to which this insurance applies takes place. 13. Broadened Notice of Occurrence Paragraph a. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- Page 14 of 15 TIONS) is hereby deleted and replaced by the foltowuT a. You must see to it that we are noti- fied as soon as practicable of an 'occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the'oc- anrence' or offense took place; (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any iftjury or damage arising out of the 'occurrence or offense. This requirement applies only when the 'occurrence' or offense is known to an 'authorized representative'. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 15 of 15